Sarah is an intake worker in Child Protection. A referral has come in to another worker alleging abuse and neglect of an 8-year-old child, George. George has autism and is shy and reserved, refusing to speak to people with whom he is not comfortable. The social workers have not been able to obtain any information from George, which makes it difficult to complete an assessment of risk. As Sarah listens to them discuss the case, she realizes that she knows the child through family friends. She is certain that George would be comfortable talking to her, and she might be able to discuss his home life with him. This is a clear conflict of interest, as she knows the child and family from previous connections. Interacting with her in this context might be uncomfortable for the family. However, it may be the only way that George will talk about his situation. Sarah’s supervisor is supportive of her offer to talk to George, as he feels George would not be able to understand the conflict of interest and therefore would not be uncomfortable. Sarah’s supervisor feels that George’s comfort is more important than the family’s comfort in this situation. Other team members feel that making an exception to a rule puts social workers in a precarious position, as it opens the door for other exceptions to be made. One team member worries that if George is brought into care, the situation will become more complicated, as Sarah will have to decide again whether to become more involved with the family.

1) What would you do in this situation?
2) Who would you consult in this situation?
3) Which is more important in this case – the family’s privacy, or possible risks towards George?
4) In small or niche communities, where dual relationships are likely, how can social workers maintain professional boundaries without secluding themselves?
5) Would this situation change if the reason for George’s communication difficulties was a language barrier? For clients who belong to linguistic minorities, often the only people able to translate are those who are already friends or family of the client. How might this affect the intake process?

1. What would you do in this situation?
If I were a social worker in Sarah’s position I would try to meet with George’s familiar prior to meeting with George. I hope this would allow me to assess how they felt about the situation with George and the conflict of interest. I would explain my thoughts to the family, letting them know I believed George may be more comfortable talking with someone he is comfortable with. If they were strongly against me speaking with George I would want to inquire why this is. My goal would be to find a solution that would make all participants comfortable while still finding the information needed to help George.

2. Who would you consult in this situation?
I would consult with my supervisor and the social workers already working on George’s file to form a plan of action. I would also want to consult with Georges family whom I had connections with, before I took any steps to talk with George. I would also want to consult with George to see if he really would feel comfortable speaking with me.

3. Which is more important in this case – the family’s privacy, or possible risks towards George?
I believe both the families privacy and the risks towards George are very important, and intersecting issues. As a social worker in a child welfare setting I believe it is our responsibility to ensure the possible risks towards George are the main focus.

4. In small or niche communities, where dual relationships are likely, how can social workers maintain professional boundaries without secluding themselves?
I think the best way to maintain professional boundaries with clients in this setting is to ensure social workers are setting very clear guidelines for interactions very early on. It is important to ensure clients are familiar with the boundaries that are being set and have a good understanding of why the boundaries need to be in place. I also think these boundaries need to be very consistent across the board.

5. Would this situation change if the reason for George’s communication difficulties was a language barrier? For clients who belong to linguistic minorities, often the only people able to translate are those who are already friends or family of the client. How might this affect the intake process?
I think the situation would be similar if George’s communication difficulties were due to a language barrier. It is a very tricky situation as it can lead to bias as the social worker will have prior thoughts and views on the situation. I believe, if at all possible, it is best to avoid any conflicts of interest and try to find an outside party to translate or conduct the interview. In a situation where there is no way around it I believe there must be clear guidelines for the intake process and all parties involved must be consulted with to ensure they are comfortable with the arrangement.

I agree with Emma, I would meet with the family first, however I would not attempt to gain their consent to talk to George. I would try to form as complete a picture as possible of the risk from the other tools available to me, without reference to George’s account. Unless there was strong corroborating evidence that George was being abused, I would be very hesitant to place myself in the conflict of interest. The statement that Sarah “feels certain George would be comfortable talking to her” is highly speculative. There is no certainty, and if Sarah does take this step, not only would she be violating her ethical obligation to the family, but she would also be taking advantage of her pre-existing relationship with George. If there are other workers available, they should use recognized practice methods to work with George, rather than exploit his trust in Sarah. Much of this turns on how important it is to have George speak. What if Sarah ends up pressuring him into saying what she wants to hear? It would be difficult for her to ask him questions without leading him to the conclusion she is seeking, either way. This raises a more general question for me about the extent to which a child’s testimony is considered in apprehension.

I would request a consult with a clinical ethicist if one were available – most provincial health agencies have them. As Sarah did, I would consult with my colleagues and supervisor as well. I would also contact any mentors I may have, while maintaining anonymity for George and his family. I would also talk to the legal advisors for my agency. There are apparently legal issues surrounding the reliability of a child’s testimony in court, and if the information George could provide would not be considered, there would be no point in creating the conflict of interest.

George’s safety is paramount, however it would need to be clear that he is at risk in order for any breach of professional ethics to be justified. If the wider investigation does not turn up any other indications of risk, it may not be necessary to make that decision at all.

In small communities many of these arguments would not apply, and a different approach is necessary. I agree with Emma when she said that setting clear boundaries and having clients understand the need for them is very important. Since the conflict of interest cannot be avoided, it may be possible to speak with George if his family consents. I would still argue that it is necessary to guard against excessive intervention however; despite the fact the conflict of interest is inherent to the situation, it is still necessary for the social worker to mitigate it as much as possible.

The language barrier is an interesting twist. Many government agencies employ a phone-based real-time translation service that could help with communication, however it would not solve the problem of George being uncomfortable with strangers. Ultimately, the same principles would apply as in a small community. The social worker must recognize the power dynamics at play and try to identify her own attitudes, biases and hopes for the client.

From a theoretical perspective, this brings two theories into conflict. Sarah has a duty not to exploit her relationship with George, and to respect his family’s wishes. She is also obligated to ensure that no harm comes to George, that is, she is concerned about the consequences of taking no action. The former is an example of a deontological principle; Sarah is duty bound to maintain her professional integrity and that of her relationship with George and family. The latter is utilitarian, in that the ethical nature of the decision rests in what that consequences will be to George, i.e. if he will be at risk of harm.

Finally, the point Hannah made about one of the social workers being concerned that making an exception would lead to more exceptions down the road is an example of a slippery slope argument. This sort of argument usually relies on a logical fallacy, and seems to in this case. There is no evidence or other reason to think that by making an exception in one case, more would inevitably follow. The ethical dilemma in this case is highly contextual and would be relatively rare, unless the setting were niche as in the rural twist on the case.